If you’re reading this article you (or someone you love) are either suffering from shin pain or investigating ways to treat or get relief from Medial Tibial Stress Syndrome (shin splints). Shin splints is a term describing the splintering pain felt along the edge of your shin bone while running or exercising.

This article explains what causes shin splints, what are the symptoms you should be looking out for and what relief you can expect from physiotherapy treatment.

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What IS Shin Splints?

Shin splints is a cumulative stress disorder. Repeated pounding and stress on the bones, muscles, and joints of the lower legs prevent your body from being able to naturally repair and restore itself.

The pain associated with shin splints results from excessive amounts of force on the shin bone and the tissues attaching the shin bone to the muscles surrounding it. The excessive force causes the muscles to swell and increases the pressure against the bone, leading to pain and inflammation.

Shin splints can also result from stress reactions to bone fractures. The constant pounding can cause minute cracks in the bones of the leg. The body can repair the cracks if given time to rest. However, if the body doesn’t get time to rest, the tiny cracks can result in a complete fracture or a stress fracture. We will discuss stress fractures and complete fractures as well.

If you have severe shin splints, your legs may hurt even when you are not walking.

How do you get shin splints?

Shin splints is a general term describing the pain, felt on the front of your lower leg, while exercising. There are muscles and tendons attached to your shin (Tibia) bone which help in controlling your movements and preventing you from getting injured. For example, when jumping your muscles and tendons work together to prevent your heel from forcefully banging into the ground every time you land on your feet. It is important for these muscles and tendons to work together to lessen the stress on the shin bone.

Non-stop strain on the muscle and tendon (where they connect to your shin) result in the tearing of the tendon and inflammation of the muscles. Micro-tears develop first in the tendon but can become one large tear over time. Stopping an activity because of the intensity of pain on your shin, can indicate that a stress fracture might be developing.

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Symptoms of shin splints

Causes of Shin Splints 

Understanding what causes shin splints helps patients understand why and how their current activities or excises may be increasing their pain and/or worsening their injury.

  • Exercising too fast and pushing your physical limits too far, too soon. (Overload and/or overuse)
  • Activities or sports with a stop-start pattern of putting strain on your legs e.g. running, tennis, soccer
  • Repetitive high impact landing (on hard surfaces) or forceful jumping e.g. dancers jumping and landing on concrete floors

What makes Shin Splints worse

  • Increasing the number and intensity of your training sessions (Too fast, too far, too soon)
  • The rigidity of your feet and related tissues e.g. having flat feet or a very rigid foot arch makes it more likely for you to develop shin pain
  • Working out on hard surfaces e.g. running barefoot on a tar road
  • Wearing worn out shoes which don’t absorb the shocks to your feet and legs while running. Note: After 500 km, running shoes absorb half the amount of shocks compared to new running shoes.
  • Tight and/or weak calf muscles
  • Running down a slope or incline, or running on uneven ground
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Why is your shin splints not going away?

The first rule of shin splints is to REST your leg. Take away the aggravating factor. That is, rest from the thing that originally made you feel your pain. Shin splints is the body’s way of showing you that you are doing more than it can handle. We usually see people come back over and over again due to shin splints, because:

  • They are not resting the leg as recommended
  • Not doing their stretching protocol that their Physio gave them
  • Failure in completing the rehabilitation program in order to strengthen the lower limb
  • They are going back to their sporting activity too soon at a too high level
  • The use of pain medication to numb the pain while they keep participating
  • Not paying attention to their nutrition

Other diagnostic tools for shin splints

X-Rays and MRI scans for shin splints

X-rays and MRI’s are negative with shin splints, but they may help to diagnose stress fractures. In the case of shin splints, an x-ray will not indicate anything, but it will show periosteal thickening an extra lining of bone formation during the healing process) in the case of a stress fracture.

MRI scans will be able to identify a stress fracture, but will be overly costly and redundant if the goal is to diagnose shin splints.

Ultrasound scans for shin splints

An Ultrasound scan is the best diagnostic tool (other than our clinical testing) to detect shin splints. Although an ultrasound will not be able to see the bony elements, it can pick up on swelling around the bone, indicative of either a stress fracture or shin splints. MRI scans will be needed to differentiate between the two.

Self-tests for shin splints

  • Squeeze your calf on your affected side
  • If you have pain in the front if your shin bone, you may have shin splints
  • Stand on a small step
  • Jump off onto the ground, bare feet
  • If you have a sharp pain in the shin bone, you may either have a stress fracture or shin splints
  • Visit your Physiotherapist to differentiate between the two
  • Sit comfortably with your shin exposed
  • Tap hard with your first two fingers on the spot where you are feeling your pain
  • If you feel a dull ache, it may be shin splints
  • If you feel a sudden, sharp pain, it may be a stress fracture
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Progression from shin splints, to stress fracture, to a full tibial fracture

Shin pain

Your calf muscle is too tight to sustain the stretching forces that your body requires in order for you to run, jump or skip. As a result, the calf muscle pulls away from the shin bone where it attaches on the front. This in turn, causes swelling, inflammation and pain. Every “hard” step you take, then reproduces that pain and the cycle goes on. If you don’t rest, recover and rehabilitate your lower leg properly, and if you continue with strenuous activity, you may cause a stress fracture.

Stress fracture

A stress fracture can be due to two reasons:

  1. An abnormal force placed on a normal bone
  2. A normal force placed on abnormal bone

Abnormal force means that the force that is expected from the body is more than what the body can handle at the time.

Abnormal bone means that there is something pathological within the bone itself, and the activity has nothing to do with the stress fracture. Examples are low bone density, osteoporosis, osteochondritis, and the female triad (to be explained in a later article, but it comes down to nutrition, amenorrhea, frail bones, especially seen in active females).

Signs for stress fracture:

  • Pain in your shins even when you’re resting
  • Your shin feels hot after walking
  • Severe pain in your shin after a fall or accident
  • Swelling in your shin area that gets worse

Tibial fracture

A Tibial fracture is the last step of damage to your shin bone when you have not seized the loading activity that originally caused the shin splints, or rested and rehabilitated the lower leg enough after a stress fracture. A stress fracture is a small line fracture within the bone. If you do not comply with the rest and treatment advised, your stress fracture can turn into an actual fracture. Meaning, the bone has broken. This results in now taking all the load off your leg. You will be in a cast or moon boot for 6-8 weeks, and on crutches until the fracture has healed. Only then can rehabilitation commence. It really is worth listening to your body at the very first signs of shin splints!

How do we Diagnose shin splints?

Through a physical exam, our physiotherapists  diagnose the cause(s) of your shin splints and advise the shortest and most effective route to relief from shin pain. We perform a number of tests including calf length, ankle stability and neural tests. Your shin pain may also be from overloading due to weakness elsewhere, so we perform other tests as well to determine if your pain comes from a different site.

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Recovery time

The minimum recovery time includes a resting period of 2 to 4 weeks from any sport or exercise. Alternatively, you can switch to other low impact activities (e.g. such as swimming or cycling). Shin splints can take between 3 to 6 months to heal.

Caution: DO NOT rush back into your preferred sport, exercise or activity. Rushing your recovery could cause your shin splints to return and/or worsen.

Physiotherapist Shin Pain Treatment

Chronic management: (Week 4 onwards)

  • Alfredson’s heel drop protocol
  • Ankle stability protocol
  • Glutes activation protocol
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Getting relief from shin pain – Self Treatment

  • Rest
    Take all the time necessary to rest and help your body to heal
  • Ice the affected area
    In intervals of 15-20 minutes apply ice 3 times a day for 3 days or until the pain is gone
  • Dynamic stretches
    Stretching will improve muscle length and reduce the pulling of the muscle on the shin bone
  • Medicate
    Taking Ibuprofen or Cataflam (NSAID) will help decrease the swelling.
    Rubaxin (a muscle relaxant).can help relieve the tension in the muscles.
  • Wear foot support
    A large variety of products including arch supports, insoles or inserts (to wear inside your shoes) are available at Dischem and Clicks.
  • Go slower, for a shorter time
    Incrementally increase your training time and intensity.
  • Warming up before and stretching after exercising.
  • Avoid exercising or training on hard or uneven surfaces.
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What NOT to do

  • Don’t do any STATIC stretches

  • Don’t run while in pain

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I must run! What now?

In a worst-case scenario, if you are stubborn and you refuse to listen to any medical advice, a compression brace could help support the muscles to minimize the friction. Strapping the calf muscle with semi-elastic strapping can help ease the tension. If this strapping is applied too tight, you will compromise the blood supply to your foot and risk permanent damage. Get expert advice from our team at Cilliers & Swart before you commit to one or both treatments for temporary relief from shin pain.

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Differential Diagnosis- What else could my shin pain be?

  • Stress fracture
  • Compartment syndrome
  • Tibial fracture
  • Tibialis anterior strain
  • Neuropathy
  • Shin pain also known asTraction Periostitis, Medial Tibial Traction Syndrome, Lower leg pain, Shin pain, Anterior tibial pain, Medial tibial stress syndrome, MTSS, Exercise cause leg pain, Tibial periostitis, Posterior tibial shin splints, Shin splints
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